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Provider Information for 1861755571



DR. DEVIN LYNN DAVIDSON D.M.D.

Gender: MALE

Individual NPI: 1861755571

Calendar Last Updated: 2014-01-15

Details

Name Value
NPI 1861755571
Enumeration Date 2012-06-18
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 777 N 500 W SUITE 106
PROVO, UT 84601-1541
United States

Phone: 801-636-5106 | Fax:
View Map External Link
Primary Practice Address 777 N 500 W SUITE 106
PROVO, UT 84601-1541
United States

Phone: 801-636-5106 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist UT 8634531-9922